Tumors of the pleura

Tumors of the pleura are very rare. From benign tumors observed lipoma, handsome, fibroma, angiology, leiomyoma and others Among malignant tumors distinguish cancers and sarcoma.
Primary cancer of the pleura develops from covering its mesotheli. Sarcoma come from podmazochnyh layers P. Tumor on can occur on the visceral and parietal sheets and on any surface it (diaphragmatic, mediastinal or midlevel).
Mesothelial cancer (see Mesothelioma) may occur on the surface of the pleura as a stand-alone single-node or diffuse spread P., infiltrating it; easy as if covered with the case. First, cancer P. may be asymptomatic. With the growth of the tumor pain in the corresponding half of the chest, cough, pleural cavity accumulated effusion first serous, then hemorrhagic and shortness of breath, fever. With the defeat of mediastinal pleura sometimes there compression syndrome. Early appear metastases in regional lymph nodes, lungs, P. from the opposite side.
Metastatic tumors P. result hematogenous metastasis in breast cancer, sarcoma of the bone, and malignant tumors of other localizations. Sometimes in Petrograd can grow tumors of the lungs or chest.
The diagnosis is established on the basis of: a) careful x-ray examination; find either a stand-alone node chest wall or diffuse thickening of the pleura; b) puncture of the pleural cavity and study the cellular composition punctate; C) thoracoscopy.
The differential diagnosis should be borne in mind tumors of the mediastinum, lungs, encysted parietal pleural effusion, pleural infiltration.
X-ray diagnostics. Primary benign tumors of the pleura on chest x-ray are clearly defined rounded, oval, lobed shadows (sometimes with inclusions of lime), adjacent broad base to the chest wall during breathing shifting together with edges (Fig. 2). Radiography in a straight line, side, and the tangential oblique projections and especially tomography, as well as study after the imposition of artificial pneumothorax can clearly reveal parietal and extrapulmonary location of the tumor. Benign tumors grow slowly, can be a very large, pushing, but not sprouting easy. Bronhografii establish that the bronchi are pushed aside, draw close to each other, a few stavlenniku from the outside, but passable (Fig. 3).
Among malignant tumors distinguish limited and diffuse forms.
Limited pleural mesothelioma is represented in the form of a semicircular, ill-defined shadows. Dimensions and their number is gradually increasing; tumors these progresses, inevitably complicated by pleurisy, sprout in the lung and chest wall, destroying adjacent ribs. Approximately half of the patients are associated diffuse giperostos limbs with artralgia. Differential diagnosis with subpleural located peripheral lung cancer is very difficult; only study after the imposition of artificial pneumothorax (if not pleural cicatrices) distinguishes mesothelioma parietal P. from lung cancer.
Diffuse pleural mesothelioma occur much more frequently than limited. Radiographically determined thickening of leaflets P. shown by the presence of multiple polyacrylic shadows, merging with each other, also located parietal, and covering all the sheets P. (Fig.4). Nodes located on the front and the rear wall of the chest, when studying in direct projection presented in the form of a round shadow, as if located intra-lungs; however, side and especially tangential x-rays and CT scans can clearly reveal parietal their location.
Such x-ray picture of diffuse pleural mesothelioma can be considered very characteristic. Often acceding effusion pleural cavity can significantly complicate the interpretation of changes. When a tumor on diaphragmatic P. left there to put down and flattening of the body of the stomach. During follow noted puckering affected half of the chest with mediastinal shift towards destruction. In the terminal stage of the tumor may metastasize to the lung tissue and lymph nodes in the mediastinum. Artralgia with diffuse hyperostosis are also seen frequently.
When miliary dissemination diffuse mesothelioma on the leaves of P. radiographically may be a picture of exudative pleuritis, nothing radiographically not different from pleurisy any etiology. Detection of mesothelioma in these cases, promotes the x-ray examination of the puncture of the pleural cavity with the removal of the exudate and the imposition of pneumothorax: bogatoe easy due to thickening of the visceral pleura seems rigid, its volume when breathing is not changed (Fig. 5). In all cases of mesothelioma Cytology punctate is an important method of diagnosis.
Unlike conventional effusion, mediastinum in diffuse mesothelioma is shifting to defeat because of the developing fibrothorax.
Lymph nodes of the root of lung and mediastinum are often affected by metastases. The tumor may grow in the lung, pericardium and mediastinum, squeezing the blood vessels of the latter, which is revealed when angiography.
Secondary (metastatic tumor P. determined more often than primary mesothelioma. Radiographically they are characterized by the appearance of the picture exudative pleurisy, which is often extremely difficult, and often impossible to distinguish from primary diffuse pleural mesothelioma and pleural effusion non-neoplastic origin. Metastatic pleural effusion is more often unilateral, bilateral less.

Fig. 2. A benign tumor of the pleura on the right.
Fig. 3. A benign tumor of the pleura on the right, a large size, pushing back the bronchi.
Fig. 4. Diffuse malignant tumor of the pleura on the right.
Fig. 5. Diffuse malignant tumor of the pleura right after the imposition of pneumothorax. Thickening of the visceral pleura nodes on parietal pleura.

Treatment with one isolated host online - lobectomy or pulmonate with resection of the chest wall (see Light, operations), diffuse form is symptomatic. Intrapleural introduction tiofosfamida (Thiotepa) and sarcolysin helps reduce exudation.